Beginning Journey for Ottie - CKD and diabetes

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Kili

Kili

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PART 2 continuation from thread

Having read the prior post from Veronica & Babu-chiri, I am wondering whether anyone else has experience with phosphorous binders available in UK.

So far, Veronica & Babu-chiri, suggested 2 other possibilities that are better than the Ipakitin which is calcium based.
- Renvela
- Nefrokrill

I have zero experience with phosphorous binders as you may know... any experience/advice will be greatly appreciated.
 
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Continuing the topic of phosphorous binders...

There seems to be 2 camps of thought.

1. Feed the binder with every meal that the cat has.
2. Feed the binder twice or once a day (depending on the binder) as directed on the packaging.

Does it really make that much of a difference?
 
Kili said:
Continuing the topic of phosphorous binders...

There seems to be 2 camps of thought.

1. Feed the binder with every meal that the cat has.
2. Feed the binder twice or once a day (depending on the binder) as directed on the packaging.

Does it really make that much of a difference?
Click to expand...
Actually it does depend on the binder for example aluminium hydroxide as far as I know is best if taken with every meal, in the case of Renvela I give it twice a day with food ( still is given with the food ) and not on every meal ( my cats free feed so they pretty much eat all day)
 
BACK TO TOPIC OF CKD

Recently, as you all know my dear Ottie has both CKD and diabetes. He was first diagnosed with CKD, followed 2 weeks later by diabetes.

When he was initially diagnosed with CKD... by the suggestion of the vet, we changed Ottie's diet immediately to Royal Canin renal diet.
Prior to changing on the renal diet, Ottie pee'd a lot and his litter had to be changed every 3-4 days. Immediately after changing to renal diet, the most noticeable thing was that the volume of his pee dropped drastically, and it was sufficient to change the litter once a week.

Since the diagnosis of diabetes... after great amount of debating in my head... we decided it was best to control his diet by putting him on a low carb diet, with low phosphorous with the help of phosphorous binders.
That meant that the renal diet, which is typically high in carbs had to be stopped.

The change in diet now... which is low carbs (below 4%), resulted in a noticeable increase in pee in his litter. Not as bad as before, but much more than during renal diet.
I am worried... Should I be worried?

I have still not started the insulin ProZinc yet... because of delivery issues... Would this improve once his diabetes is under control?
 
Kili said:
The change in diet now... which is low carbs (below 4%), resulted in a noticeable increase in pee in his litter. Not as bad as before, but much more than during renal diet.
I am worried... Should I be worried?
Click to expand...
Both diabetes and CKD are going to cause him to drink more water and pee more. nothing to do about it and nothing to worry but unless you notice that he's straining to pee, peeing in unsual places, blood in the urine or something that could point to UTI (urinary trackt infection) which would require the vet to deal with it
 
Exactly. When Bobo got diagnosed with CKD was basically the increased drinking and peeing that got me to take him to the vet. He wasn’t diabetic yet but when he became diabetic too, the amount of drinking and pee was kinda overwhelming. I’d find his rather large water bowl almost empty every morning, all 3 litter boxes full. Once the diabetes got regulated, it got better.
 
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Veronica & Babu-chiri said:
Both diabetes and CKD are going to cause him to drink more water and pee more. nothing to do about it and nothing to worry but unless you notice that he's straining to pee, peeing in unsual places, blood in the urine or something that could point to UTI (urinary trackt infection) which would require the vet to deal with it
Click to expand...

Not sure whether he is straining to pee... but he seem to spend slightly longer than I remember to pee... But the wee he produces seems only slightly more than usual.
It's hard to make an accurate judgement... but he doesn't have other signs... Could it be UTI?
 
I'm not sure whether I'm doing things properly... but I received all the kit today, and just did my first blood glucose reading at 5pm... using the AlphaTrak 2
and it came in at 9.7 mmol/L. The test was carried out a few minutes after I fed Ottie. Prior to that he hasn't had food for 2-3 hours.
Ottie is a grazer and is incapable of having a large meal. I know it's just one reading, but made me question whether Ottie even has diabetes. However, that can't be when the blood test proved otherwise right?

In the past week, we have changed his diet to low carbs. He eats Blink in Jelly... which is supposed to have less than 4% carbs. Would that change things so quickly for Ottie?

What setting do most of you use for lancing device? Is 4/5 too high?
 
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Sorry I can’t help because I don’t know pet meters. I also don’t use a device, I free hand. I find I have more control over the pressure I’m applying that way. Minnie was also not a fan to the clicking sound.
 
Ale & Bobo & Minnie (GA) said:
Sorry I can’t help because I don’t know pet meters. I also don’t use a device, I free hand. I find I have more control over the pressure I’m applying that way. Minnie was also not a fan to the clicking sound.
Click to expand...

I did it freehand for my first prick, but had to do it 3 times because it wasn't drawing any blood. Ottie freaked after the first poke. I'm in pain just watching his ear, and feel so bad I hurt him.
Still had to squeeze the blood out, but he kept trying to shake his head. Videos make it look so easy, but I guess their cats are very cooperative.

After that experience, it made me think I should use a lancing device.
 
So far, I have done two readings.

At 5pm the reading was 9.7 (last eating was 4pm)
At 8.45pm the reading was 12.6 (Ottie last ate at 7pm about 1/4 of pouch)
Keep in mind that Ottie is a grazer, and rarely eats much in one go. He at most eats half a pouch, and often much less. He eats something every 2 hours, but never a big meal at once.

So far, I cannot see any reason to even think about giving Ottie insulin. (I think this statement is wrong, and Ottie needs insulin)
Do I need to go back to the vet, and ask whether insulin is even necessary?

His diabetes was diagnosed because he did a blood test where his glucose came in at 15.2 mmol/L with a range of 3.8 - 7.6.
Then he also did a urine analysis, where traces of glucose was found.
He also did another blood test which was a fructosamine test, and the result came in at 477 when the upper range is 360.
So after all that, he was diagnosed diabetic. Vet said it's not possible to tell how diabetic he is, but I find that really hard to believe when there is a scale. I was told that you are diabetic when you go over the threshold, and how much you are beyond that doesn't determine how diabetic he is.

6 days ago, I changed his diet to be low carb. Ottie currently eats Blink in Jelly. Could the diet make that quick of a change?

The thing I am confused by is that I have no idea what the range should be for his blood glucose.
 
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Ale & Bobo & Minnie (GA) said:
Did you warm up the ear and did you aim for the sweet spot? What gauge size lancets are you using?
Click to expand...

I am currently doing the ear pricking freehand. The Lancing device I have came with the AlphaTrak 2 starter kit, but it doesn't seem to work at all, and the needle of the lancet doesn't even poke out of the hole.
I think it is 28 gauge.

I do warm up the ear, but sometimes forget because there's so much going on. I'm not sure
 
Can anyone advise. My glucometer is AlphaTrak 2.

I have not administered any ProZinc insulin yet. Trying to get a idea of Ottie's readings... Very scared of hypoglycemia.
Ottie rarely has a big meal, and grazes throughout the day. He struggles to eat 1/3 of a pouch of wet food in one go. He eats about 1/4 pouch every 2 hours.
He has around 3-4 pouches a day. Not sure if it's because the food is not quite as tasty... but he needs a lot of encouragement to eat compared to before.
His diet mainly consists of Blink in jelly... but he's not 100% fond of it, so I mix it with Sheba fine flakes which so far seems to go down well. I am feeding him Blink because so far, it seems low in sodium as well as phosphorous (for his ckd). Both Blink and Sheba, I believe has less than 5% carbs.

So far, have completed 3 readings.
17:00 the reading was 9.7 mmol/L (my first ever reading. This was very hard.)
20:44 the reading was 12.6 mmol/L
23:20 the reading was 12.7 mmol/L

So... in summary...
16:00 food
16:54 9.7
17:00 treat
17:10 food
20:44 12.6
21:15 food
22:15 food
23:20 12.7
23:22 food

My vet suggested 1 unit of ProZinc twice daily. Is this the right dose? When is the reading too low for injection? When should I consider missing injection because BG is too low?
My vet also said as long as he's had about 1/3 of a pouch, it's sufficient to inject ProZinc. Is this true?

I'm sorry about all these questions... but in all honesty, I'm scared of everything that can go wrong. Thank you all for your patience and experience.
 
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I really don’t know pet meters. If you set up a spreadsheet it would automatically convert the numbers so we could all help. Also, members are reluctant to give dosing advice without seeing any spread sheet data. I’m tagging @Bandit's Mom who can help you with that and a few others @Sienne and Gabby (GA) @Bron and Sheba (GA)

you listed the times above but I have no idea when he had insulin and when he’s suppose to have it again. If my calculations are correct you got a 228 which last but again, I don’t know when you’re suppose to give insulin @Red & Rover (GA) is that correct?

when you’re seeking immediate dosing help, it’s best to start a new thread with a title listing the pmps and asking should I shoot or not, to get more eyes on it. Otherwise, the urgency gets lost in your old thread
 
Ale & Bobo & Minnie (GA) said:
you listed the times above but I have no idea when he had insulin and when he’s suppose to have it again. If my calculations are correct you got a 228 which last but again, I don’t know when you’re suppose to give insulin @Red & Rover (GA) is that correct?

when you’re seeking immediate dosing help, it’s best to start a new thread with a title listing the pmps and asking should I shoot or not, to get more eyes on it. Otherwise, the urgency gets lost in your old thread
Click to expand...

NO INSULIN GIVEN yet. (Sorry I used capslock so that it stands out). Trying to get more information before I do any injection. o_O I have started a thread here, to hopefully get some specific advice about ProZinc.

All the readings I wrote previously is without any insulin.
16:00 food
16:54 9.7 mmol/L
17:00 treat
17:10 food
20:44 12.6 mmol/L
21:15 food
22:15 food
23:20 12.7 mmol/L
23:22 food

My vet has prescribed 1 unit of ProZinc, but just wondering whether it's correct dosage. I will get a spreadsheet going once I start on ProZinc.

I'm also trying to get an idea of when the BG reading is too low to administer any ProZinc insulin. For example... If I get a reading of 8 mmol/L, is it too low for insulin injection? Do I skip?
Am I right to assume that reading above 10 mmol/L is an easy go signal for insulin?
 
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With the testing you have shown us and a fructosamine test of 477 I think your kitty is diabetic.
The BG levels fluctuate during the day.
If your kitty has been diagnosed with diabetes and you are not starting insulin straight away, I would recommend you test daily for ketones in the urine using Ketostix strips. Diabetic cats that are not getting insulin are at risk of developing ketones which can develop further into DKA which is dangerous.
If you are using an alphatrak meter the normal range for a non diabetic cat is 68 (3.7) to approximately 150 (8.30). We can't say exactly as there has been no true comparisons done between the human and pet meter numbers, so this is just an estimation. If you were using a human meter, which most of us use here, we can tell you that the normal range for a nondiabetic cat is 50-120. (2.8-6.6)
I would set up a spreadsheet as Ale has suggested and get all the numbers you are telling us into the SS so we can see. We can't give dosing advice without seeing a SS.
Here are the dosing methods for PROZINC
I would suggest you use the start low go slow dosing method (SLGS).
The starting dose if you are using SLGS and feeding a low carb wet diet is 0.5 U. This is the dose I would start with.
Make sure you are using the correct U40 insulin syringes.
Initially if the BG is below 200 (11) I would either skip or stall, dont feed and test again in 20 minutes to see if the BG is rising. And post and ask for help.
I would let Ottie graze as normal, but pick up the food for the 2 hours preshot.
Keep asking questions.
I am tagging @Suzanne & Darcy as she is a prozinc user
 
16:00 food
16:54 9.7
17:00 treat
17:10 food
20:44 12.6
21:15 food
22:15 food
23:20 12.7
23:22 food
00:30 food
02:20 food
=======================
05:00 treat
05:05 food
05:15 food
05:25 food
07:10 food
10:10 food
10:20 food
11:09 9.2
11:41 ProZinc 0.5 units injected.
11:50 food

I have started on 0.5 unit, but I am not sure whether this amount does anything. It is so small in quantity, that I actually found it hard to measure.
I have not figured out how to do spreadsheet, and then get it linked up on googlesheets yet.
 
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You've been getting some great information. Since you've switched your kitty to a low carb diet, I agree with Bron -- start on a lower dose of Prozinc (i.e., 0.5u). It's much easier on your nervous system to start at a lower dose especially if you're still in the process of mastering home testing. It will give you and Ottie a chance to get used to testing and lessen the possibility of numbers dropping low whereby you have to test more to monitor what's going on.

With someone who is new to the process, we suggest a pre-shot reading of 200 is a point to post and ask for help. You have a couple of options and an experienced member can walk you through those options.

We just cross posted. Good job with the testing and shooting! Yes -- it looks like a tiny bit of insulin. However, think about the relative size of your cat. Cats are small. They don't need the same amount of insulin as a human might. Also, insulin is a powerful hormone. With many cats, it doesn't take much to see results. I'd encourage you to get a test in 2 hours (or less) to see the effect.

I'm tagging Bhooma (@Bandit's Mom ). She can give you a hand getting your spreadsheet set up.
 
05:00 treat
05:05 food
05:15 food
05:25 food
07:10 food
10:10 food
10:20 food
11:09 9.2
11:41 ProZinc 0.5 units injected.
11:50 food
12:55 food
13:50 4.8
13:55 food

I'm surprised that with only 0.5 units, after +2hrs post insulin injection, Ottie's BG dropped to 4.8. I hope it doesn't go lower.
 
I just posted on your thread in the Prozinc forum. This is essentially what I posted:

You did fine. I'm linking a post from the Lantus board that addresses how to deal with low numbers. Lantus is a very different type of insulin than Prozinc. When it comes to lower numbers, the principles are pretty much the same.

When you get a lower number (right now, that means below 90 or 8 on your meter), you use a teaspoon or two of higher carb food to bump up the numbers. You then re-test in about 20 minutes to see if the numbers are rising. You repeat this a few times to make sure the numbers are in a good range and don't start to drop again.
 
You want to withhold food for at least 2 hours for the preshot tests so you’re getting a bg that is not influenced by food and you know it’s safe to shoot. I think the reason the .5 dropped him so much is because you gave him food within those 2 hours so the bg you got was elevated and not the true bg.

Great job giving insulin for the first time :bighug::bighug::bighug:
 
Looks great! Now I can see the color coding but I can also go to the US tab and see the US equivalent numbers so it makes it a lot easier for any of us to help you. Well done you!

I would just say to input the numbers you got yesterday as well since that’s when you started insulin

it’s not often that we see recently diagnosed cats in the blues and greens so he’s doing really well :bighug::bighug::bighug:
 
My biggest confusion from the beginning has been the same... How do I know when his BG is too low that a shot is not warranted?
Also, it's not clear what the desired range is since everyone has a different range. Ottie seems to be on the borderline, but again not sure.
My vet tells me to maintain dose of 1 unit for a week, and then do a curve. If I did that... Ottie would have already crashed once.

With the help of some people here, I have done 0.5 units of ProZinc. I'm not sure how you would even do 0.25 units. It was really hard just measuring 0.5 units because it's so small.
And by the looks of things in this forum... we keep adjusting the insulin according to the BG readings... So how do you even judge that?
 
I’m going to use the numbers in the US tab. We tell beginners that if the preshot is lower than 200 to stall without food, post here and ask for help and retest in 20 minutes. This is so you can see if the bg is naturally doing up or not and make a decision on whether to shoot full dose or not. I think Bron mentioned that above and I think Sienne gave you a link for the Lantus explaining some of that. Is there something in that info specifically you’re confused about? However, you shot with a preshot lower today and it seems to be going well. I’m thinking you can shoot anything above 150, @Bron and Sheba (GA) what do you think?

Not sure what you mean by everyone has a different range. The range you’re aiming for is the normal range. I’m copying the info Bron gave you here again: “you are using an alphatrak meter the normal range for a non diabetic cat is 68 (3.7) to approximately 150 (8.30). If you were using a human meter, which most of us use here, we can tell you that the normal range for a nondiabetic cat is 50-120. (2.8-6.6)” This is the desired range you want Ottie in most of the time because that’s when his pancreas can start to heal.

You should do a curve every 2 weeks. Did you read all the yellow sticky notes in the prozync forum yet? It has a lot of info that will help you understand the dosing methods.

I believe here folks can get the U40 syringes 1/2 unit marked which makes it easier to eye ball the 1/4 units. I’d recommend you do some online search to see if they’re available in the UK
 
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Btw, we ask members to like the comments made on their threads so we know you read them. I want to make sure you did read the comments I mentioned above by Bron and Sienne :)
 
The numbers for what is "low" differ for whether you're following Start Low Go Slow (SLGS) or Tight Regulation (TR), although with Prozinc, TR is adapted to the modified version of the dosing method. With Prozinc, you want to be following SLGS. At the beginning, if you get a pre-shot number that's lower than 200, post and ask for help. In general, you will have 3 options:
  • Stall. Do NOT feed your cat. Re-test in 20 - 30 min. If numbers are on the rise, it's usually safe to shoot.
  • Shoot a reduced dose. You will need to get some help on how to calibrate the dose.
  • Skip the shot. This is typically an option if the numbers are much lower than expected and you won't be around to monitor.
Please keep in mind, that each situation can be different. It's why we suggest posting and asking for help. Again, in general, the Health forum tends to be busier than the Prozinc page. You don't want to have people who are trying to help jumping between places and it can be confusing for you if different people are giving you conflicting information. Try to keep information in one place until you have a handle on what you're doing. Also, as you gain confidence with dosing and managing Ottie's diabetes, you will become more comfortable with shooting progressively lower numbers. With my kitty, I would shoot anything over 50 (although, I was a Lantus user).

(As for "liking" posts, I personally don't think it's necessary. I tend to not always look at the "likes" since my "Alerts" box can get rather full. If it's a busy day here, I won't look at the "likes" unless I have time.)
 
Ale & Bobo & Minnie (GA) said:
You want to withhold food for at least 2 hours for the preshot tests so you’re getting a bg that is not influenced by food and you know it’s safe to shoot. I think the reason the .5 dropped him so much is because you gave him food within those 2 hours so the bg you got was elevated and not the true bg.

Great job giving insulin for the first time :bighug::bighug::bighug:
Click to expand...
This is what I was saying over on theProZinc forum.
 
I know that previously a member mentioned that I should drop my dosage from 0.5 unit to 0.25 unit... BUT do you guys realise that 0.25 unit is literally one single drop of insulin? I squirted it on my hand for reference, and was surprised how neglible the amount was.

I gave him as discussed here 0.25 unit. His PMPS reading was 12.1. So far, it seems like Ottie's BG is low during the day, but higher during the evening post 10pm.
 
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I’m not sure anyone said you should reduce it now. I think it was said you may have to if/when he earns a reduction, with the SLGS method you decrease if he goes under 90 on a human meter. Did you read my comment about getting 1/2 unit marked syringes? I’ve had to give Bobo 1/4 unit, just look at how spreadsheet, I even had to give him .1 unit and 1 drop as well. 1/2 unit marked syringes make it easier @Suzanne & Darcy ?
 
With my insulin, am I trying to hit an ideal zone of 5.6-11.1 or am I supposed to hit an ideal zone of 3.8-5.5.

Yesterday, I have 0.25 unit as his early AM shot had a reading below 5... but it didn't go much below 9.1, so I returned to the original dose of 0.5.
Was that the right thing to do?

Ottie's PMPS is 13.7... gave a 0.5 unit Prozinc, and +2hr reading is 8.1... Is that too low, too fast?
 
Ale & Bobo & Minnie (GA) said:
I’m not sure anyone said you should reduce it now. I think it was said you may have to if/when he earns a reduction, with the SLGS method you decrease if he goes under 90 on a human meter. Did you read my comment about getting 1/2 unit marked syringes? I’ve had to give Bobo 1/4 unit, just look at how spreadsheet, I even had to give him .1 unit and 1 drop as well. 1/2 unit marked syringes make it easier @Suzanne & Darcy ?
Click to expand...
He dropped below 90. Both @Shelley & Jess and I said he had earned a reduction. We also addressed the issue that is it a small amount of insulin. I had previously suggested that she not follow the vet’s recommendation of starting at 1 unit and I said to cut it to .5. It was pointed out to me that the .5 was a small amount of insulin. Yes, but Ottie dropped bow 90 on that small amount of insulin. Therefore, I also said that, per SLGS, a reduction to .25 units should be given going forward. I understand that.25 units is a small amount of insulin. I am aware of this. Nevertheless, insulin is a hormone and not a drug. Cats are sensitive to small insulin changes and doses. Ottie may eventually need to go back up to .5 units, but the dosing protocol is written with safety in mind. Therefore, last night I said (and Shelley too) that the new dose was .25 units going forward and was to be held for 7 days/14 cycles unless another reduction was earned during that time.
 
247 - 146
Ale & Bobo & Minnie (GA) said:
I’m not sure anyone said you should reduce it now. I think it was said you may have to if/when he earns a reduction, with the SLGS method you decrease if he goes under 90 on a human meter. Did you read my comment about getting 1/2 unit marked syringes? I’ve had to give Bobo 1/4 unit, just look at how spreadsheet, I even had to give him .1 unit and 1 drop as well. 1/2 unit marked syringes make it easier @Suzanne & Darcy ?
Click to expand...
she said she has theU-40s with the 1/2 unit markings
 
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